VOLUME 15
April 2014
APRIL SHOWERS
BRING
MAY FLOWERS!
Editorial Notice
This newsletter is published
monthly for Dr. Parham Mora
645 McQueen Smith Road.
Suite 205
Prattville, Alabama 36066
Editorial Staff:
Melissa Grant
Items for the newsletter must
st
be submitted by the 1 of the month
for consideration for publication in
the upcoming issue!
submit items to:
[email protected]
If you no longer wish to
receive
Bariatric
Bulletin,
Bariatric
Coordinator.
contact:
[email protected]
Bariatric Bulletin,
NUMBER 4
What is Dumping Syndrome? How can I avoid it?
by Kaye Bailey
Dumping syndrome is an effective result of the gastric bypass system which alerts the body of
inappropriate eating. Dumping syndrome is described as a shock-like state when small, easily
absorbed food particles rapidly dump into the digestive system. This results in a very unpleasant
feeling with symptoms such as a cold clammy sweat, pallor, butterflies in the stomach and a
pounding pulse. These symptoms may be followed by cramps and diarrhea. This state can last for
30-60 minutes and is quite uncomfortable.
That was the clinical description of dumping.
This is what I experience when I dump: shortly after eating a food I don’t tolerate
(sugar, milk, sugary milk products or starchy carbs) I begin to feel a bit disoriented,
maybe dizzy and then an overall sense of confusion or panic takes over my mind
and body. This is a mild state of delirium. Then I begin sweating. Profuse sweating
that can completely soak my hair, my clothes; it drips and glistens on my skin.
During this state of sweaty panic I feel like I’m out of my mind! A few times during
extremely dramatic dumping episodes I literally thought I was dying, the state of
distress was that severe.
At this point during a dumping episode I have learned it is best to lie down on my side and let it
nature take its course. The body is efficiently, albeit painfully, correcting a chemical imbalance in
the cell system. It takes great presence of mind to calm myself and lay down, but even in a state of
near-delirium I now know this is the only action to be taken. I know the event is passing when the
sense of panic is replaced by exhaustion and cold chills instead of sweating. Occasionally I have
suffered diarrhea at this point. If I have the luxury I’ll try to take a nap or go to bed after dumping.
If it is in the evening I’ll sleep through the night, and wake feeling like I’ve been run over by a
truck.
The mild delirium associated with dumping is the result of an interruption of nerve impulses
affecting cerebral metabolism. The interruptions are caused by metabolic disturbances such as
fluid or electrolyte imbalance. When the incorrect foods are consumed and dumped into the
digestive system the electrolytes get out of balance. Dehydration will also cause an electrolyte
imbalance. This mild delirium is characterized by a reduced ability to maintain attention to
surroundings or disorganized thinking. The daily routine can become confusing. In extreme cases
a person who is dumping may experience rambling, irrelevant or
incoherent speech.
The Four Rules
After the dump passes the interrogation begins: what caused that dump? I have dumped on
yogurt, sugar cookies, lobster bisque and blackberry sorbet. I have dumped after one margarita. A
particularly impressive dump followed a love-fest with a piece of pecan pie. Salty potato chips that
should have never crossed my lips knocked me flat quicker than a prize-winning boxer could
have. I have dumped a few times for which I never determined a cause. In most cases eating the
inappropriate food for my gastric bypass system is the culprit. Through trial and error I can
predict most things that make me dump and I avoid them contemptuously.
The most efficient way to avoid dumping is to maintain the strict regimen practiced during
bariatric infancy: follow the four rules. Eat protein first making sure it comprises one-half of every
meal. Avoid snacking. Avoid all sources of simple sugar; and yes, this includes cookies, cakes,
candy, sodas, ice cream and sorbet. Sip water throughout the day. When you practice this eating
behavior your blood sugar will not fluctuate and you will not dump. Most patients, who crave a
taste of something sweet, have learned they can tolerate a bite of fruit at the end of the meal.
Proceed with caution and discover what works for you.
The first reaction when dumping begins is to try and make it stop. There is a feeling of
helplessness – like trying to stop an earthquake. I have tried eating myself out of it. I have tried
flushing it away by drinking water. I have tried physical motion – pacing – to get myself out of it. I
have not successfully stopped a dumping episode. I don’t know anyone who can successfully halt
a dumping episode. Sipping a sports drink like Gatorade will relieve my symptoms, although my
surgical weight loss specialists do not recommended this practice. If you find something to bring
relief during a dump, and it causes no further harm, then do it.
It is important to note that the dumping experience is different for every person. Some will always
have extreme dumps and others more mild episodes. Individuals will notice dumping episodes
will vary by incident. No two people dump the same and no two dumps are alike.
Dumping is a bittersweet fact of life after weight loss surgery. Because we must fuel our bodies by
eating we will experience dumping. Adherence to the four rules will prevent dumping in most
cases. However, every now and again we will be blindsided by a dump caused by a food never
suspected. Keeping a list of poorly tolerated foods will help you avoid them. The acutely dramatic
event of dumping is a convincing motivator to follow the rules and avoid the foods that have
trigged a dumping episode.
http://www.livingafterwls.com/Library/Dumping.html#featured
Belly Fat: You Got to Move It to Lose It
Carry your weight around the middle? This action
plan will help you to lose belly fat and win the battle
of the bulge.
Distribution of body fat may have more impact on your
overall health than total body fat. That's why it's
important to know if you are an apple or a pear.
To determine if you are an apple or a pear, you first need
to understand the difference between the two types of
body fat.
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Subcutaneous fat is the type found just underneath
the skin—the fat you can “see.”
Visceral fatlives deep within the torso, wrapping itself around your heart, liver and other
major organs. Visceral fat is especially dangerous because it releases certain substances that
are linked to heart disease, hypertension, diabetes, stroke and even some types of cancer.
Measure Your Risk
Men whose waists are wider than 40 inches and women whose waists are wider
than 35 inches are at the greatest risk for developing health problems.
Though men tend to collect more visceral fat around their middles (apple
shape), women typically store fat around the hips, butt and thighs (pear shape).
But women are prone to develop an apple shape, and hence more visceral fat,
after menopause.
Are You a TOFI?
Studies are finding that seemingly “thin” people can have high amounts of visceral fat too.
Researchers have coined them TOFI, which means, “Thin on the Outside, Fat on the Inside.”
If you are sedentary, you can expect to accumulate a steady amount of hidden visceral fat year
after year, even if your weight remains stable. And studies are finding that there are more health
risks linked with thinner people who are sedentary than slightly heavier people who exercise
regularly.
If you are visibly overweight, with a large amount of subcutaneous fat, you most likely have a
high amount of visceral fat too. But if you are thin, it can be hard to tell just by looking.
You Got to Move It to Lose It
Exercise is the best way to prevent and reduce belly fat, but you also have to watch your portion
sizes and eat a healthy diet.

Exercise 30 minutes most days of the week to help to
prevent an increase in visceral fat.

If you already have excess visceral fat, shoot for 60
minutes of exercise most days of the week.

Work some strength training into your routine at least
two days a week.

Spot exercising, such as doing sit-ups, can tighten
abdominal muscles, but it won’t get at visceral fat.
Remember that staying trim is only half the job of keeping
healthy. If you’re inactive, it’s time to start an exercise
program.
http://mynewselfbariatrics.webhealthyrecipes.com/Weight-Loss-Surgery/Good-Health/BariatricFitness/Belly-Fat-You-Got-to-Move-It-to-Lose-It.html
Advanced: Straight-Arm Shrug
Targets: Shoulders, biceps, triceps
 Stand with feet hip-width apart, arms extended straight
out to sides at shoulder height, holding a dumbbell in each hand.
 Keep arms straight as you lift and lower right shoulder to
ear.
 Switch sides; repeat.
 Do 30 reps, alternating sides, keeping arms lifted entire
time.
Advanced: Overhead Bend
Targets: Shoulders, triceps, core
 Stand with feet shoulder-width apart,
holding a dumbbell in each hand.
 Bend right elbow to hip and hinge over to
left from waist.
 Extend right arm overhead and to left,
keeping shoulder down.
 Lower elbow to hip.
 Do 25 reps; switch sides and repeat.
Goblet Squat
Targets butt, quads, inner thighs, and hamstrings
Stand with feet wider than shoulder-width
apart, toes turned out, holding handle of a single
dumbbell vertically with both hands in front of
chest (like a goblet), elbows bent out to sides.
Squat, bending knees 90 degrees. Make it
harder: Holding weight in place, jump up slightly
as you rise out of squat, landing with knees soft.
Do 2 to 3 sets of 15 to 20 reps.
Three-Way Lunge
Targets butt, quads, inner thighs, and hamstrings
 Stand with feet hip-width apart, hands
clasped in front of chest. Lunge forward with left
leg (knees bent 90 degrees); return to start.
 Lunge left leg out to left, toes facing
forward, and bend left knee 90 degrees. Return to
start.
 Lunge backward with left leg to complete 1
rep. Repeat sequence with right leg.
 Do 2 to 3 sets of 15 to 20 reps, alternating
sides.
And the
WINNER of our" before and after" contest
is...... Maribeth Smith
Repulsion…hate…fear…depression…self-loathing…
I know every single one of those feelings. And I hated every single one of those
feelings. Weight wasn’t just something that I battled. It was something that I lived day in
and day out of my entire life. Please don’t get me wrong, I’ve never been all doom and
gloom about it. I’ve always been a happy person. I’ve laughed and loved and have
never felt “less” because of weighing more. I’ve made jokes about being in shape
because “round is a shape” and that I preferred being heavy because I saw it as a built
in defense mechanism. No one would want put forth the effort to try to snatch me, hurl
me over their shoulder and hoist me into the trunk of the car for fear of long-lasting back
trouble. And if running away wasn’t an option in a scary situation, I could always be
counted on to simply sit on the assailant until either help arrived or he passed out from a
lack of oxygen to the brain.
But I’ve always, ALWAYS, felt like I could hear those words in the backs of peoples’
minds saying “she’s so sweet and so funny, and she’d be so pretty if she could just lose
that weight”. And I can’t count the amount of times that I’ve heard, “she has such a
pretty face”. Again, my brain hears a comma and the rest of the sentence that they
filtered out. “It’s just the rest of her that isn’t so pretty”. I know 99% of this is in my head,
and not theirs and that was something that I learned to deal with when I was fairly
young.
I played sports in high-school, and because of that was able to control my weight to
some extent. But after graduation in 2004, when I didn’t have a coach yelling at me to
run laps around a softball field, I stopped running laps around anything. And the weight
gain commenced. I’d diet and lose 20 pounds, then I’d gain back 30. I’d get serious
again, lose 35, and then gain 40. It was a cruel, vicious cycle that I was completely
aware of, and completely unable to break. I felt like this was just the way my life was
going to be.
I had a baby in the fall of 2009. When I got pregnant, I was a solid 220 pounds. I was
perfectly healthy, just heavy. Every blood test I had showed normal levels. My
cholesterol was low, my blood pressure was low. Looking at lab-work, you’d think I was
a fit, skinny lady. I had a very simple, very uncomplicated pregnancy that resulted in a
gorgeous, strong baby boy. I’ve never wished for a baby’s birth weight to be 40 pounds
more in my life. I had ballooned up to 260, and felt sure that it would just come right off.
I was ever so wrong. It just kept coming. I couldn’t stop. I ate like every meal was my
last. I never wanted to exercise because the thought of someone seeing me outside
working out or walking paralyzed me in fear. I continued to gain. And the clothes got
tighter, and the number on the scale got bigger, and the voices in my head of disgust
towards myself got louder. It wasn’t until the fall of 2011 when I was told that because of
my weight, Tyler would be our only baby. My body was no longer working the way that it
needed to in order for us to get pregnant again. My heart broke. Tyler wouldn’t have a
sibling. My husband, who is one of six kids, and wanted several of his own wouldn’t get
to have another one because of me. My weight was no longer just affecting ME. It had
crossed a line and had taken away something from all of us and that was the promise of
another child. I. Was. Devastated.
I began to consider gastric bypass surgery after that talk with my obstetrician. He
referred me to Dr. Mora and we began the process of getting me back to a weight that
even if I couldn’t have another baby, I would be around to raise the one that I had. I was
26, and over 300 pounds.
The entire process of getting everything approved, tests done, preliminary doctor’s
visits, and pre-operative lab work took just over 4 months. I had my surgery on May 29,
2012 and started down a new road. Every single Tuesday, for an entire year, my
husband took a picture of me, and I was able to put the date, weight that I had lost, and
the total amount that I had lost out beside it for us to be able to track my progress. I
made my journey public and posted every picture on Face book. I fed off of the
encouragement and the compliments, and found that by doing this journey with the
world watching, I was ensuring that I would hold myself accountable and that slipping
back into my old ways wouldn’t be an option. I never wanted to put that I had gained
weight. Turns out, fear is a great motivator; and it motivated me down a total of 125
pounds.
Then, in March of 2013…the miracle of all miracles for me…. My body, who had refused
to give me another baby, found itself with a wee one growing inside. Apparently, the
drastic weight loss had “kick-started” my lazy ovaries and our beautiful daughter, Sara
Audrey, was born in November after another very easy pregnancy. Because of not
being able to eat like a “normal” pregnant woman does, and not being able to get the
vitamins and nutrients that it would take to sustain us both, I took a daily cocktail of over
15 vitamins to get us to the finish line. I only gained 17 pounds my entire pregnancy,
and within 5 days of having my gorgeous girl, I had lost those 17 plus about 6 more.
I am a HUGE advocate for the support group meetings. This monthly get-together has
kept me on track more than I ever thought possible. At first, I thought I’d go to the 3 that
were required before surgery, and then they’d never see me again. Instead, I fell in love
with the people there and it has become one of my very favorite things to look forward
to. I have said time and time again, that your friends and your family will love you and
support you, but they won’t “get it” the way the folks in this support group do. I’ve used
the analogy that this weight loss journey is like a river with bends, twists, and currents.
Those closest to us are on the river with us, side by side us in a kayak. But the friends
that I’ve made within this support group are in a canoe with me. We are quite literally, in
the same boat. Making the decision to have this surgery, and to radically change my life
is, hands-down, the very best decision that I’ve ever made for myself. I would go back
and do it again in millisecond without a second thought.
It was such a close race! Thanks for everyone's
participation in our contest! Melissa Pierce was our second place
and Alice Pilgreen was the third place winner. Everyone looks so good
and I am very proud of each and everyone of you. Keep up the great
work!!
Chicken Pita Recipe
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o
o
Ingredients
1 Tbsp balsamic vinegar
 1 scallion, chopped
3/4 Tbsp sun-dried tomato oil or olive oil  1/2 Tbsp capers,
1 Tbsp chopped drained oil-packed sunrinsed and drained
dried tomatoes
 2 Tbsp thinly sliced
1/8 tsp black pepper
fresh basil
1/8 tsp dried tarragon
 3 (6-inch) pitas, cut
1 garlic clove, minced fine
in half
2 cups shredded or chopped cooked
 1 1/2 cups mixed
chicken breast
baby greens
1/2 cup chopped tomato (about 1 small)
1/4 cup (1 oz) grated part-skim mozzarella
cheese
Preparation
In a large bowl, combine vinegar, oil, sun-dried tomatoes, black pepper, tarragon and garlic.
Stir in chicken, tomato, cheese, scallion, capers and basil.
Line each pita half with 1/4 cup greens. Divide chicken mixture evenly among pita halves,
about 1/4 cup per pita half.
Yield: 6 servings
IMPORTANT PORTION SIZE INFORMATION:
Post weight loss surgery patients must carefully measure ingredients and portion size. Consult with
your physician for your individual portion size guidelines. Freeze leftovers in single-serving portions
for future meals.
IMPORTANT PATIENT INFORMATION:
This recipe is appropriate for many meal plans for weight loss surgery patients medically approved to
eat solid food. To determine if this recipe is safe for you, consult your physician.
* Nutritional information is based on ingredients listed and serving size; any additions or
substitutions to ingredients may alter the recipe's nutritional content
Broccoli and Cheese Recipe
Heart Healthy Recipe Diabetes Recipe
Here’s a tasty way to eat your vegetables. This healthy recipe
for broccoli topped with a delicious cheese sauce will become a
family favorite.
Ingredients
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
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1 1/2 lbs broccoli florets (about 9 cups), cut into bite-size pieces
1 Tbsp all-purpose flour
1 cup skim milk
1/2 cup (2 oz) shredded reduced-fat cheddar cheese
3 Tbsp grated fresh Parmesan cheese
1/8 tsp salt
1/4 tsp black pepper
Preparation

o
o
o
Place 1 inch of water in a medium saucepan. Place a metal colander on top of saucepan. Put
broccoli in the colander. Place lid on the pot or on top of colander. Bring water to a boil
over high heat. Reduce heat to a simmer and steam for 4 minutes or until broccoli is forktender. With tongs, transfer broccoli to a bowl. Set aside.
Place flour in a medium saucepan over medium-high heat. Gradually add milk, stirring
constantly with a whisk until smooth. Cook for 2 minutes, or until mixture thickens, stirring
constantly. Cook for 1 additional minute, stirring constantly. Remove from heat.
Add cheeses, salt and pepper, stirring with a whisk until smooth. Quickly pour cheese sauce
over broccoli and serve immediately.
Yield: 8 servings
Quote of the Day
"We cannot live for ourselves alone. Our lives are
connected by a thousand invisible threads, and along
these sympathetic fibers, our actions run as causes and
return to us as results."
– Herman Melville
About Herman Melville
American author Herman Melville is best known for his epic whaling novel, Moby-Dick, which
wasn't recognized as a masterpiece until after his death. He was born in New York on August 1,
1819. At age 20, he went to sea on a whaling ship. His seafaring adventures included time with
cannibals in the Marquesas Islands, the basis for his successful novel Typee. His later, more
philosophical, novels were not as well received as his early adventure yarns, and he died in
obscurity on September 28, 1891.
Melissa's Corner
Wow! Where has the time gone? The
year is almost half gone. My sweet
grandson Ian is the cutest bunny I have
ever seen! He is going to be a year old
on the 17th of May. I can't believe how
much love and joy he has brought into
our lives. His pappy and I keep him just
about every weekend, so if you see us
out and about, you can bet he will be
in tow. Our son has just turned 16 and
received his license this past week and
once school starts back next year, he will be a junior in high school. Our
daughter will be 21 this August! Wow! I sure feel old!
I am working on trying to get speakers to come speak in the coming
months. Currently you would like to hear from a plastic surgeon and a
pilates instructor. If there is someone else you would like to hear speak
please let me know and we will look into it!
You can now hear our commercial on Bama
Country 98.9 and Q96
To reach me it is
[email protected]. Please make a note of this and
change it in your address book. If you don’t have Email please make sure I know. This is how I do a lot of
my communication with you.
Search morasurgicalclinic
Don't forget about our website www.morasurgicalclinic.com
We will feature a new weight-loss story every month.
You can now see us on the big
screen at the Prattville Promenade
IMPORTANT!! IMPORTANT!!
IMPORTANT!!
1. Maintain a healthy, low calorie diet that is
low in carbs and fat, but rich in protein. Your
water intake should be at least 64 oz. per day.
2. Exercise (walking, jogging, swimming, biking, cardio, etc.) 1 hour per day, 5
days a week.
3. Take vitamins and prescribed minerals without fail.
4. Seek out help from a mental health care individual (psychiatrist, psychologist)
to learn new ways of coping with stress as needed.
5. If you are a lap band patient and you have had an adjustment to your band,
and start having problems keeping foods or liquids down that day, that night,
or the next day, CALL US IMMEDIATELY and let us know. Adjustments are
usually done on Mondays and Wednesdays when Dr. Mora is in clinic. You
MUST let us know by Friday if you are experiencing problems so Dr. Mora can
evaluate you before the weekend. Do not go over 24 hours without reporting
problems to us or you can damage your band.
6. If you are a gastric bypass patient, 3 months or more out from surgery,
have your lab-work done one week prior to your follow-up appointments.
7. Regularly attend support group meetings.
Please write a story of YOUR weight loss
story with pictures and submit to Melissa
@ Dr. Mora’s office for publication in
the newsletter. Submit to
[email protected] or call
the office @ 361-6126, ext 2
IS THERE A TOPIC YOU WANT TO SUGGEST
FOR OUR NEWSLETTER OR SUPPORT
GROUP MEETING? IT’S A GREAT TIME TO
LET US KNOW!!! WE WANT TO HEAR FROM
YOU! The support group meetings and
newsletters are for you, our patients. We want
to make sure you’re getting the information you want from
both the meetings and the monthly newsletters. Send your
suggestions to Melissa at [email protected] or
call the office
361-6126, ext 2
UPCOMING SUPPORT GROUP MEETINGS
**PLEASE NOTE! WE HAVE THE DATES LISTED BELOW FOR SEMINARS THROUGH SEPTEMBER 2014
NOW, SO MARK YOUR CALENDARS TO ATTEND!
LOCATION:
Prattville Doster Community Center
424 South Northington Street, Prattville, AL.
TIME: 6:00 P.M. -7:00 P.M.
DATE:
2014 April 28, May 19, June 23, July 28, August 25 and
September 22
PLEASE note all dates are subject to change due to availability of Dr. Mora or other
extenuating circumstances. We encourage you to call to check that the date has not
been moved ahead of time each month, especially if you live out of town!
GUIDELINES FOR SUPPORT GROUP MEETINGS

Everything said and heard in the group will be treated with respect for the
participants’ privacy. What is said in the group stays in the group.
• Silence is acceptable. No one needs to say anything she/he does not wish to say.
The group is supportive rather than judgmental.
• The group offers respect for individual choices and experiences.
• Only one person talks at a time.
• Turn off all mobile phones and pagers.
• No one is allowed to dominate the conversation.
• The group facilitators’ roles must be respected.
• Begin and end meetings on time.
• The group is a safe place to share feelings, and to obtain and provide support,
information, reassurance and encouragement.
• The group is broadly defined. It is flexible; flowing with the participants’ needs
and interests, and provides an opportunity to reduce feelings of isolation.
• Bariatric surgery support groups are open to all persons going through the
surgery process, including family members and others in a supporting role.
• Although the results of going to the group can be therapeutic, the group is not
meant to replace individual behavior therapy.
• Every effort should be made within the group to resolve conflict arising from or
during group interaction.
If you have any concerns or questions after attending one of our meetings, please feel free to contact Melissa
confidentially by email at [email protected]